All too often, family members, friends, fellow employees, and even therapists become reactive, judgmental, and walk on eggshells when they interact with someone who displays characteristics of borderline personality disorder. Let me start off by summarizing some of the core characteristics of the disorder, specifically focusing on those traits which play out in the interactions with others.

Affective Instability – This is where those with BPD struggle to regulate their emotions in predictable ways. Often, their mood does not match with expected life or social situations, thus making it difficult for those around them to understand or relate to the distress they are experiencing.

Fear of real or imagined abandonment – Those struggling with BPD are often afraid of being rejected, abandoned, or left alone emotionally. These feelings are triggered when the potential abandonment is indicated, as well as times where it isn’t.

Identity disturbance – It can be difficult for those with BPD to maintain a consistent sense of self. There is typically a variance of self-doubt, instability in self-image, and self-acceptance.

Impulsivity – Due to the emotional and personal instability, impulsivity is often a regular occurrence for those with BPD. While this may not feel disruptive for the individual, it can be highly disruptive for those around them.

Paranoid ideation and dissociative symptoms – In certain situations, those with BPD may struggle with feeling paranoid, especially in relation to how they perceive other’s intentions or motives. Also, they may experience dissociative symptoms, which is a disconnect from themselves, their reality, or their sense of self.

What we need to understand about personality disorders is that they are just that, disorders which occur within the core personality of the individual. This is important to consider, because it is extremely threatening to the individual when a personality disorder is suggested, or when a diagnosis is made, especially since it is difficult to be “objective” about your own personality. Because of this, it can be very threatening for someone experiencing symptoms of BPD to identify and accept that the symptoms are present in their life.

It is my professional belief that the symptoms of BPD are treatable, and that through treatment, people can reduce the identified symptoms to the degree that they no longer qualify for the diagnosis. This perspective can bring hope to those struggling with BPD, as well as those who are involved in their life. However, the process of therapy can be challenging, and typically requires long-term treatment.

Selecting a therapist who can treat BPD effectively is an important step in the process. The therapist must be able to accurately diagnose the disorder, as well as position themselves in the therapeutic relationship as to control for and manage the identified symptoms. A careful balance between soliciting BPD symptoms and maintaining safety and security within the therapeutic relationship is critical. Failure to challenge the BPD symptoms results in no change, while doing so without carefully creating a safe therapeutic relationship will typically result in early or even immediate rejection on the part of the client.

Once someone with BPD can effectively accept the diagnosis, identify how the symptoms play out in their life, and learn new ways of managing and responding to the symptoms, then they can focus on the primary relationships in their life, and work on how they relate to others in new ways.

Written by Dr. Tony Alonzo, DMFT, LMFT, CFLE therapist at the Holladay Center for Couples and Families

All too often, family members, friends, fellow employees, and even therapists become reactive, judgmental, and walk on eggshells when they interact with someone who displays characteristics of borderline personality disorder. Let me start off by summarizing some of the core characteristics of the disorder, specifically focusing on those traits which play out in the interactions with others.

Affective Instability – This is where those with BPD struggle to regulate their emotions in predictable ways. Often, their mood does not match with expected life or social situations, thus making it difficult for those around them to understand or relate to the distress they are experiencing.

Fear of real or imagined abandonment – Those struggling with BPD are often afraid of being rejected, abandoned, or left alone emotionally. These feelings are triggered when the potential abandonment is indicated, as well as times where it isn’t.

Identity disturbance – It can be difficult for those with BPD to maintain a consistent sense of self. There is typically a variance of self-doubt, instability in self-image, and self-acceptance.

Impulsivity – Due to the emotional and personal instability, impulsivity is often a regular occurrence for those with BPD. While this may not feel disruptive for the individual, it can be highly disruptive for those around them.

Paranoid ideation and dissociative symptoms – In certain situations, those with BPD may struggle with feeling paranoid, especially in relation to how they perceive other’s intentions or motives. Also, they may experience dissociative symptoms, which is a disconnect from themselves, their reality, or their sense of self.

What we need to understand about personality disorders is that they are just that, disorders which occur within the core personality of the individual. This is important to consider, because it is extremely threatening to the individual when a personality disorder is suggested, or when a diagnosis is made, especially since it is difficult to be “objective” about your own personality. Because of this, it can be very threatening for someone experiencing symptoms of BPD to identify and accept that the symptoms are present in their life.

It is my professional belief that the symptoms of BPD are treatable, and that through treatment, people can reduce the identified symptoms to the degree that they no longer qualify for the diagnosis. This perspective can bring hope to those struggling with BPD, as well as those who are involved in their life. However, the process of therapy can be challenging, and typically requires long-term treatment.

Selecting a therapist who can treat BPD effectively is an important step in the process. The therapist must be able to accurately diagnose the disorder, as well as position themselves in the therapeutic relationship as to control for and manage the identified symptoms. A careful balance between soliciting BPD symptoms and maintaining safety and security within the therapeutic relationship is critical. Failure to challenge the BPD symptoms results in no change, while doing so without carefully creating a safe therapeutic relationship will typically result in early or even immediate rejection on the part of the client.

Once someone with BPD can effectively accept the diagnosis, identify how the symptoms play out in their life, and learn new ways of managing and responding to the symptoms, then they can focus on the primary relationships in their life, and work on how they relate to others in new ways.

Written by Dr. Tony Alonzo, DMFT, LMFT, CFLE therapist at the Holladay Center for Couples and Families

In my career in healthcare, I have seen far too many patients who have been prescribed medication and continue to take that medication faithfully; Yet after a time, they are not really sure why they are taking that specific medication or if it is even helping with the diagnosed issue.

What is missing for these patients? Medication management.

Medication management is the process of following up with the healthcare provider on a regular basis to assess the effectiveness of the prescribed medication therapy, discuss any side effects that may go along with the medication, and make adjustments in order to achieve proper dosing. In some cases, the follow-up may be to change the prescribed medication therapy, if it is not providing the desired outcomes. Medication management should be an ongoing process. It should include open dialogue between the patient and provider about the effects of the medication combined with any other therapies or treatments that may be in place. This is to ensure useful data is being collected, so decisions can be made based on the whole picture; not just the medication piece.

When it comes to psychiatric and mental health services, the importance of quality medication management cannot be overemphasized. Not all people who seek psychiatric help will require medication. In some cases, amino acid therapy may be appropriate or continued therapy and counseling with regular psychiatric follow-up is warranted. If medication is prescribed, the patient should plan to see the psychiatric provider within 2 weeks (in most cases) for the first medication management visit. Continued follow-up visits should be scheduled monthly, or as needed depending on the individual case.

During these visits, the patient should plan on communicating openly with the psychiatric provider about their use of the medication, any side effects that they may be noticing, and any changes they are feeling in relation to their mental health diagnosis. At times, genetic testing can be used to pinpoint what medications are more likely to work for each individual patient. This testing can be used not only for patients who are just beginning psychiatric treatment but also for patients who have been prescribed medication therapies that aren’t working. The patient should also plan to consult with the psychiatric provider before taking any other medications. They should inform the provider of other mental health therapies being used or medical complications that may arise during treatment. The patient should expect the provider to ask questions that will direct and lead the conversation, so time is well spent and modifications can be made with confidence.

Ultimately, the key to effective psychiatric medication management is open and continual communication between the patient and provider. At the Center for Couples and Families, our psychiatric providers strive to provide thorough psychiatric assessment, follow-up, and medication management.

People are often worried about drudging up the past with their loved ones. There is controversy as to what is healthy for the relationship. People certainly don’t like to bring up an old fight when everything is going well. The issue is that we all have a closet of sorts where we hide everything that “isn’t worth the fight.” At first this closet is empty and the intention of putting things in there is good, you intend to talk about it later, it’s just not the right time.

The problem is that you enjoy the times you’re not fighting, who wouldn’t! You soon forget about what you’re storing in the closet, and you continue to throw everything “not worth the fight” into the closet. Your closet becomes full, and when you try to fit one more thing in there everything topples over. This is the fight of all fights, this is when you seemingly “loose it” out of nowhere about nothing and everything. This fight happens at a time when something was already “not worth the fight” and you were trying to put it in the closet. Therefore, you are probably not up for resolving everything in that closet either. It’s like if your junk closet toppled over just as company is coming over, you’re going to scoop everything up and stuff it back into the closet because you don’t have time to sort through it. This fight leaves everyone upset and confused and often nothing is resolved in this fight.

So how does one clean out this closet? Well its much like spring cleaning, you are going to take everything out and you begin to sort everything into categories. You evaluate if it is something that only happened once and will never happen again, if this is the case it truly isn’t worth the fight and can be thrown out. If it is something that continues to happen you need to address it, you will be bringing up the past not as a weapon against the other person, but as a justification for bringing it up as an issue. It is absolutely necessary that cleaning this closet is done at a time when your calm and you remain calm to be able to assess what the core of the problem is, what does their behavior tell you about your relationship with them. For instance, If someone is always late, how does their behavior effect you, why does it feel disrespectful to you and how does it create distance in your relationship, what is the message you receive about their feelings toward you. As opposed to judging their behavior as something you wouldn’t do and lecturing them about how it affects them.

When you clean out the closet you are transferring responsibility to the people it will be useful with. You will find that the cleaner your closet becomes the more clarity you will have in your relationships. Your intent in cleaning out the closet is not to change other people’s behavior, it is meant to change your relationships. You will find that some people will choose to become more distant because they are unwilling to make changes, but the relationships that become closer and the internal peace will be worth the distance in others.

Written by Madison Price, MS, LAMFT – therapist at Holladay Center for Couples and Families

Studies show about 1 out of every 6 adults will have depression at some time in their life. This means that you probably know someone who is depressed or may become depressed at some point. We often think of a depressed person as someone who is sad or melancholy. However, there are other signs of depression that can be a little more difficult to detect.

Trouble Sleeping

If you notice a change in a loved one’s sleeping habits pay close attention as this could be a sign of depression. Oftentimes depression leads to trouble sleeping and lack of sleep can also lead to depression.

Quick to Anger
When a person is depressed even everyday challenges can seem more difficult or even impossible to manage which often leads to increased anger and irritability. This can be especially true for adolescents and children.

Losing Interest
When someone is suffering from depression you may notice a lack of interest in past times he or she typically enjoys. “People suffering from clinical depression lose interest in favorite hobbies, friends, work — even food. It’s as if the brain’s pleasure circuits shut down or short out.”

Appetite Changes
Gary Kennedy, MD, director of geriatric psychiatry at Montefiore Medical Center in Bronx, New York cautions that a loss of appetite can be a sign of depression or even a sign of relapse back into depression. Dr. Kennedy also points out that others have trouble with overeating when they are depressed.

Low Self-Esteem

Depression often leaves people feeling down about themselves. Depression can lead to feelings of self-doubt and a negative attitude.

What to do
If you suspect you or someone you love may be suffering from depression talk about it, encourage him or her to get professional help and once he or she does be supportive. Remember thatat times symptoms of depression need to be treated just like any other medical condition.

In cities throughout the world, notable high buildings and bridges increasingly have additional fencing built atop of them with the specific purpose of preventing suicides. Suicide fences tend to work because research has shown that suicidal actions are frequently impulsive, hence such fences serve to forestall that impulse and buy individuals precious time to further think about their decisions. In studies of suicide fences, it appears that individuals don’t leave such barriers to go look for another bridge or tall building to end their lives from, but instead return to the business of living for yet another day.

Presently suicide is the leading cause of death among young people ages 10-17 here in Utah, and over the last decade, it’s also doubled amongst adults in our state. As concerned friends, neighbors, and parents, how do we help our community build more barriers to suicide; protecting and empowering those we love? Over the next year, I’ll be writing a series of articles in answer to this question; offering my perspective as both a therapist, who has stood on sacred ground in helping others walk back from suicidal thinking, and as one who’s felt and ultimately rejected the dark pull to end my life amidst heavy times.

Perhaps you’ve already noted that there’s no way to build suicide fences everywhere or to somehow block all of the endless ways in which someone might consider ending their life. Sound public policies on prevention and physical barriers like suicide fences are only some of the important ways to help. So in addition to these forms of prevention, the focus of my writing will be on how to build barriers to suicide directly into the thinking and values of individuals, and into the culture of our community as a whole. In this first article, I want to introduce how we help foster an ethic to live within ourselves and in others as a key barrier to suicide.

An ethic to live means valuing our lives and holding a commitment within ourselves to continue living — even when we’re unsure of how we’ll cope or move forward. In my experience, helpful conversations about consciously building an ethic to live, begin by first taking care to turn our attention to the reality that to live is to be vulnerable to an array of difficult life experiences, with the potential to evoke within us the thought to end one’s life to escape them. Throughout human history, individuals and peoples have had to confront extremely painful and unjust challenges which have overwhelmed their sense of being able to continue on, and it’s important to acknowledge that when we confront such considerable pain, it is the most human thing in the world to want relief from it. This is real; excruciating human suffering beyond one’s current sense of how to reduce or stop it is real, and in these concentrations of pain, we may find ourselves having suicidal thoughts.

When we acknowledge and honor that such excruciating life experiences do show up for many of us, it’s then that we can locate where we need to begin building internal fences to prevent suicide. It’s here that we recognize the need to develop a strong ethic to live even though there are times that we might not yet fully know how we’ll cope or be able to see brighter ways forward. It’s also here that we find the need to define as individuals what makes life worth living with specificity to our own life experiences, as well as the need to find a listener who we can turn to and voice what’s going on inside of us.

As you navigate life’s difficulties, no matter how hard things may get, make the commitment now to live and identify your personal reasons to do so. Additionally, identify suicidal thoughts as a sign to find a listener who you feel safe enough to talk to. It’s worth thinking about right now who it is you might feel comfortable turning to during your hardest times. By doing so, you’ll begin to build your own internal fence between you and suicide as well as have greater insight as to how to help others you care about to do the same.

* If you or someone you care about is currently having thoughts of ending their life, caring help is available 24/7 by texting 741741 from anywhere in the USA or you can call 1-800-273-8255 to speak directly with a Counselor from the National Suicide Prevention Lifeline.

Bio: Laura Skaggs Dulin holds a master’s degree in Marriage and Family Therapy from San Diego State University. She currently sees clients at the Spanish Fork Center for Couples and Families and at Encircle LGBT Youth and Family Resource Center in Provo.

http://www.spanishforkfamilies.com/wp-content/uploads/2018/01/iStock-486335104.jpg10801160syndicatedhttp://www.spanishforkfamilies.com/wp-content/uploads/2017/02/CCF-Logo-Spanish-Fork-300x127.pngsyndicated2018-01-09 23:28:462018-02-07 21:46:43An Ethic to Live: Building Barriers to Suicide Around Ourselves & Those We Love

Our community is the epitome of mainstream America. We have deeply rooted family values, safe streets, moral standards, and most families stand guarded against outside influences that threaten our happiness. Recently, however, Utah achieved the 7th highest drug overdose rate in the nation. How can a community named Happy Valley have some of the highest rates of adult mental illness and teenage suicide in the country?

Treating addiction is clearly a necessity. However, explaining these alarming and confusing statistics may also come down to understanding some myths, or assumptions, about happiness.

Myth No. 1: I Should Be HappyAll the Time

Some aspects of our local community amplify and reinforce the well-intended message that “good people” or “my kid” should not or would not encounter pain. At times, we may even feel entitled to getting our way and therefore feel betrayed when we stress and we encounter unwanted but normal life struggles. These challenges show up as: loneliness, divorce, work stress, relationship issues, domestic violence, bullying, prejudice, low self-esteem, and chronic pain to mention a few.

Myth No. 2: If I’m Not Happy, Something is Wrong with Me

For decades, mental health symptoms have been twisted and misunderstood to the point that painful or overwhelming thoughts and feelings are now presumed to be products of weak, faulty, and unworthy minds. Labels like ‘Anxious’, or ‘Addict’ are now used so frequently and in such negative ways it distracts us from the real issue at hand. Those labels not only build a wall but also mask the reality that we all struggle in similar ways. Combine these objectifying terms with a competitive culture this myth grows more powerful and exponential.

Myth No. 3: For a Better Life, I Must Get Rid Of Negative Feelings

Every single one of us experiences self-judgment, fear, and shame of not measuring up. It can be overwhelming and discouraging. Unfortunately, we live in a culture that promotes numbing and hiding as the solution to any pain or discomfort.

Anger, over-working, blaming, over-booking schedules, and isolation has been dependable sources of distraction for years. Some argue how safe and how little impact these behaviors have on themselves and others. Ironically, they assume that dependent or ‘addictive’ thinking and behaviors are only appropriate if describing illicit drugs and alcohol. Recently, more camouflaged options like sugar, caffeine, over the counter medication, smoking, power drinks, and trendy diets have become legal and justified ways to remedy unwanted thoughts or deal with social pressures. All of these behaviors, and others, are designed to alter reality, enhance social performance, and reduce stress. Unbeknownst to us, we end up trading one form of addiction for another.

Everyone considers himself or herself an unwilling and/or unaware accomplice and each would avoid the road of undue suffering if possible. Here are three practical take home ideas that can help you start breaking yourself free from the shackles of these myths and identify and strengthen your core values so you can stay connected with reality.

Take time and energy to notice core values that you have and may share with others. Write down and/or share thoughts, feelings, and memories that help identify and strengthen your core values. Yoga, meditation, and other quiet activities will improve focus and self-awareness.

Compare less. Look for opportunities to learn about and accept the uniqueness of others. Admitting and accepting our weakness and vulnerability to others actually creates meaningful emotional and social bonds.

React less. Take a deep breath and refocus values that you can practice today.

All of us long for acceptance, empathy, and connection from others but sometimes get stuck in the attractive web of addictive behaviors. If help is needed, reach out to others or professionals. Enjoy the search for happiness in the everyday pursuit of values, not distractions.

This time I was determined to fix this on my own. After all, I had a certification in corrective exercise, how could I not fix this? At that point I realized the only person that can help me was me. I was sick of paying chiropractors and doctors to temporarily ease the pain, but never giving me a path forward so that I could enjoy aggressive sports, lifting heavy, snowboarding, or whatever I felt like doing. I thought to myself, shouldn’t these professionals know how to fix this? Well yeah, but their answer was surgery. Not mine. By the way, I realize that sometimes the only answer is surgery in certain cases. And that’s okay. But I wanted to give my body a chance to see if I could figure this one out on my own. Feeling frustrated, but hopeful, I started to study every article about sacroiliac joint pain related to exercise and nursing it back to full strength, if it was even possible. There was a lot of trial and error, stumbling along the way, and figuring out which exercises were doable and which ones I needed to avoid. I slept different. I changed my posture. Patience was needed because this was a slow process. I slowly began building up my joint strength, my core strength, hip mobility, working in different planes of motion, and finally lifting heavier and heavier weight. I succeeded. I felt as if I had never experienced this injury because I was pain free and felt strong enough that I could do anything. This was probably one of the most satisfying experiences of overcoming something that seemed impossible to do.

I feel like we all have something like this, whether it is losing fat, getting stronger, eating healthier and living a healthy lifestyle, training for a difficult event, overcoming an injury, getting over an addiction, succeeding at a business or career, and so on and so forth. My challenge to you is to be patient and be hopeful. Don’t give up. If it’s worth it to you, then give it all that you can whether that be physically, mentally, emotionally, or spiritually. Be your best self. You have the potential and you are well worth it!

My four-year-old daughter placed herself in the middle of our living room to play with blocks. She was so engrossed with building a wooden castle that she didn’t notice her two-year-old sister walking towards her with her right arm stretched far back to slap her older sister across the head. When that slap came, my older daughter went from happy to surprise to anger and then lots of tears. She ran towards me seeking justice. “Mommy, she hit me!” My younger daughter remained still, looking innocent. I immediately walked over to her with my older daughter in hand and said, “Hands are not for hitting. Say sorry for hitting please.” I’m sure many parents can relate to this scenario. Teaching our children the skills for making amends is an important life skill and is not so much about saying the words “I’m sorry”.

There is a belief amongst some parents that enforcing premature apologies on children is not effective. Their reasoning is that premature apologies teach children to lie and encourage insincerity. It also creates shame and embarrassment. Other studies show that young children have the ability to be empathetic even before they can speak; therefore, parents should encourage apologies (Smith, Chen, Harris; 2010). As I reflected on my research and my knowledge as a Marriage and Family Therapist, I recognized several things we can do as parents to create productive apologies:

Keep yourself in check: It’s frustrating to see your children fight, especially when it happens at inconvenient times. However, it’s important to remain calm and model for your children how to handle frustration.

Be immediate when possible: When you see an incident occur between your children, address it. The best time for learning and growth is when the incident is still fresh in their minds. However, when there are time constraints and the issue cannot be addressed right away, it is important to tell your children when and where it will be addressed. Be consistent when using the alternative and follow through.

Ask instead of tell: Avoid lecturing. Ask questions instead. “Tell me what happened?” “What were you feeling when you hit your sister?” Validate the expressed emotion and help them to understand that it is okay to feel frustration and sadness; however, it is not okay to hit or throw things. Help them to also make the connection between emotion and action. “Look at her face, how do you think she’s feeling right now?” Asking these types of questions enhances empathy.

Problem Solve: Ask questions about what they think they should do when they feel frustrated or sad. Help them to come up with solutions. Ask questions about how they can make things better with their sibling/s.

Have them practice a do-over: When your child identifies the solution, have them practice it with the other sibling/s. Praise them for their efforts at the end.

What is more important than the phrase “I’m sorry” is what children take away from the experience. We can facilitate and enhance learning opportunities by not focusing on the phrase “I’m sorry” but instead more on what can be learned from this situation and how can we improve.

Counseling, if done right, is husband friendly! Find the right therapist and you’ll understand. The problem is that many husbands worry that the therapist is going to take their wife’s side and gang up on him, or that therapy will be uncomfortable. While the latter may be true, the former isn’t. A good therapist doesn’t take sides or act as a referee. I have had many couples want to hash out an argument in front of me in counseling so that I can tell them who is right. I stop them, and explain that even if one of them ended up right, that they would be so wrong in their rightness – their marriage would suffer because they insisted on being right instead of compassionate and forgiving. A good therapist, rather, is able to foster healthy interactions between spouses so that they both feel safe and are able to be vulnerable and genuine with each other. When husbands understand that what they feel and think is important, then they are more willing to make this uncomfortable leap with their spouse. Women are more likely than men to initiate therapy, but without buy-in from the man, it is difficult to be successful in therapy. My suggestion to women who want to initiate counseling, but have a reluctant spouse is to recognize that this is scary for your spouse. They may feel as if they will be attacked, or worse yet, that they will lose you. Help them understand that your desire for counseling is because you love him and because you want this to work – but aren’t sure how to make fix it. Ask him to give therapy at least 3 sessions – after that, if he still feels reluctant there might be another counselor or approach that you could try. Most men feel better about therapy after at least 3 sessions if you have the right therapist for you.

http://www.spanishforkfamilies.com/wp-content/uploads/2017/12/men-2424928_1920.jpg12791920syndicatedhttp://www.spanishforkfamilies.com/wp-content/uploads/2017/02/CCF-Logo-Spanish-Fork-300x127.pngsyndicated2017-12-07 23:42:102017-12-07 23:50:35How do I Get My Husband to Come to Counseling?